Chapters authored
Videocapillaroscopy in Connective Tissue Diseases
Videocapillaroscopy is a noninvasive, quick, and easy examination method to indicate if there is clinical suspicion of microangiopathy. It provides the rheumatologist indispensable information on the microcirculation state. Recently with the development of the new classification criteria of systemic sclerosis (ACR 2013), capillaroscopy has become even more important. It is currently the only instrumental test whose result is pathognomonic for diagnosis of systemic sclerosis. During videocapillaroscopy, the following parameters are evaluated: density, structure, hemosiderin deposition, bloodstream, presence of megacapillaries, presence of subpapillary venous plexus, and edema. It can distinguish several patterns, especially scleroderma pattern, as follows: (1) “Early” pattern: few enlarged/giant capillaries, few capillary hemorrhages, relatively well‐preserved capillary distribution, no evident loss of capillaries; (2) “Active” pattern: frequent giant capillaries, frequent capillary hemorrhages, moderate loss of capillaries, mild disorganization of the capillary architecture, absent or mild ramified capillaries; (3) “Late” pattern: irregular enlargement of the capillaries, few or absent giant capillaries and hemorrhages, severe loss of capillaries with extensive avascular areas, disorganization of the normal capillary array, ramified/bushy capillaries. Although capillaroscopic examination is easy to perform, it is essential that the operator has been properly trained on the instrument’s function and on correct method of image acquisition to avoid misinterpretation.
Part of the book: Systemic Sclerosis